| NPI | 1740989573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: MI AS250414567) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: AS250414567) |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-03-01 |